采用外部冷却法控制脓毒症休克患者的发热:随机对照试验

Fever Control Using External Cooling in Septic Shock: A Randomized Controlled Trial
作者:Schortgen, F..., Clabault, K..., Katsahian, S... 【View at publisher】 【全球专家评论】
期刊: Am J Respir Crit Care Med2012年11月期185卷 专家评级:★★★ 循证评级:A

Rationale:

Fever control may improve vascular tone and decrease oxygen consumption, but fever may contribute to combat infection.

Objectives:

To determine whether fever control by external cooling diminishes vasopressor requirements in septic shock.

Methods:

In a multicenter randomized controlled trial, febrile patients with septic shock requiring vasopressors, mechanical ventilation, and sedation were allocated to external cooling (n=101) to achieve normothermia (36.5–37°C) for 48 hours or no external cooling (n=99). Vasopressors were tapered to maintain the same blood pressure target in the two groups. The primary endpoint was the number of patients with a 50% decrease in baseline vasopressor dose after 48 hours.

Measurements and Main Results:

Body temperature was significantly lower in the cooling group after 2 hours of treatment (36.8±0.7 vs. 38.4±1.1°C; P<0.01). A 50% vasopressor dose decrease was significantly more common with external cooling from 12 hours of treatment (54 vs. 20%; absolute difference, 34%; 95% confidence interval [95% CI], ?46 to ?21; P<0.001) but not at 48 hours (72 vs. 61%; absolute difference, 11%; 95% CI, ?23 to 2). Shock reversal during the intensive care unit stay was significantly more common with cooling (86 vs. 73%; absolute difference, 13%; 95% CI, 2 to 25; P=0.021). Day-14 mortality was significantly lower in the cooling group (19 vs. 34%; absolute difference, ?16%; 95% CI, ?28 to ?4; P=0.013).

Conclusions:

In this study, fever control using external cooling was safe and decreased vasopressor requirements and early mortality in septic shock.

学科代码:传染病学 重症监护   关键词:脓毒症休克
来源: Eclips
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